1985-629 BUILDING PERMIT
TOWN OF QUEENSBURY No 85- 629
WARREN COUNTY, NEW YIOIRK
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PERMISSON is hereby granted to Joseph Sullivan d
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OWNER of property located at 3323 Glen Lake Road Street, Road or Ave.
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in the Town of Queensbury, To Construct or place a Sewage Alteration
at the above location in accordance to application together with plot plans and other information hereto filed andFj-
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approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
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t. OWNER'S Address is RD # l
Lake George , New York
2. CONTRACTOR or BUILDER'S Name �
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.lay Sweet
Queensbury Sewer tj
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3. CONTRACTOR or BUILDER'S Address
RD # 1 tC
Lake. George , New Fork �d
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4. ARCHITECT'S Name
S. ARCHITECT'S Address
6. TYPE of Construction — IPlease indicate by XY
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) Wood Frame i Masonry ( I Steel R 1
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7. PLANS and Specifications
No. sewer pump and tank and extra drywell per r_A
plot and application submitted _ M
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8_ Proposed Use ri
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Sewage System for dwelling :1
$ 10 . 00 PERMIT FEE PAID - THIS PERMIT EXPIRES October 30 1987
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date_)
Dated at the Town of Queensbury this 3 Oth Day of October 19 85
SIGNED BY /. '� for the Town of Queensbury
Building and Zoning Inspector
TOWN OF OUFFNSBURY
TOWN OF {QUEE❑NSBURY
BUILDING ZONING DEPARTMENT 1E G 1`!
0 SrWAGF DISPOSA;, PERMIT APPLICATIO
1 . Owner ' s Name �l�c. I cot _ r�
Adaress _ �U 71819J .'1 "41-1213141516a
Telephone No .
2 . Property location crw le j
3 . Name person or firm respons a for installing system
%s _ S � - �� t `,� y...�. Telephone No . �{ cS
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Address
4 . Number of bedrooms ( residential buildings only) }
5e Daily flora` gallons/day
6 . Septic tank capacity. '��C� �-C� gallons
? . Topography : flat ,, rolling , _ 0 eep '
S of slope
Be Nature of soil and depth .
9 . If ground water , bedrock or impervious material is apparent at what
depth does it •begin? ft .
10 . Percolation test : A is required
B is not required
C If required what ' s t rate minutes/inch
Ile water su
PPZY - municip aZ , well , other^ ,0 _
12 . Type of system proposed • drywell the field , other
Any contractor ,, corporation , individual , etc . engaged in ' the construction
of a sanitary sewage disposal system who covers the same before inspection ,
does not have an approved permit , or varies from the approved application
will be subject to a penalty of $ 254 as pro ' ded for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance .
Date — °"-
s nat a 'o app is nt _
On separate sheet of paper submit a diagram_ of the proposed septic system
With all dimensions , including distance from any structure , distance from
property line and domestic water supply , etc . Include all dimensions of
the system itself .
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Form 3 - 82
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